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view-id-bmj_rapid_responses view-display-id-bmj_rr_article view-dom-id-0b8437275a71a99b7668a2ea312bea83\u0022\u003E\n \u003Cdiv class=\u0022view-header\u0022\u003E\n \u003Cdiv id=\u0022response-header-description\u0022\u003ERapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. \u003Cem\u003EThe BMJ\u003C\/em\u003E reserves the right to remove responses which are being wilfully misrepresented as published articles.\u003C\/div\u003E \u003C\/div\u003E\n \n \u003Cdiv class=\u0022view-filters\u0022\u003E\n \u003Cform action=\u0022\/\u0022 method=\u0022get\u0022 id=\u0022views-exposed-form-bmj-rapid-responses-bmj-rr-article\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cdiv\u003E\u003Cdiv class=\u0022views-exposed-form\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widgets clearfix\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-by\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-by form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-by\u0022\u003ESort by \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-by\u0022 name=\u0022sort_by\u0022\u003E\u003Coption value=\u0022field_highwire_a_epubdate_value\u0022 selected=\u0022selected\u0022\u003EDate Published\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-order\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-order form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-order\u0022\u003EOrder \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-order\u0022 name=\u0022sort_order\u0022\u003E\u003Coption value=\u0022ASC\u0022\u003EAscending\u003C\/option\u003E\u003Coption value=\u0022DESC\u0022 selected=\u0022selected\u0022\u003EDescending\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-per-page\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-items-per-page form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-items-per-page\u0022\u003EItems per page \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-items-per-page\u0022 name=\u0022items_per_page\u0022\u003E\u003Coption value=\u00225\u0022\u003E5\u003C\/option\u003E\u003Coption value=\u002210\u0022 selected=\u0022selected\u0022\u003E10\u003C\/option\u003E\u003Coption value=\u002220\u0022\u003E20\u003C\/option\u003E\u003Coption value=\u002240\u0022\u003E40\u003C\/option\u003E\u003Coption value=\u002260\u0022\u003E60\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-submit-button\u0022\u003E\n \u003Cinput class=\u0022btn btn-info form-submit\u0022 type=\u0022submit\u0022 id=\u0022edit-submit-bmj-rapid-responses\u0022 name=\u0022\u0022 value=\u0022Apply\u0022 \/\u003E \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/form\u003E \u003C\/div\u003E\n \n \n \u003Cdiv class=\u0022view-content\u0022\u003E\n \u003Cdiv class=\u0022views-row views-row-1 views-row-odd views-row-first views-row-last\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/352\/bmj.i93\/rr\u0022\u003E\u003Ch3\u003ERe: Teens\u2019 e-cigarette use rises as spending on advertising soars, says CDC\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003E\u201cI think we have seen this movie before . . .\u201d (1)\u003C\/p\u003E\n\u003Cp\u003EPrevious evidence (2) regarding this issue last year from the U.S. predicted increase in adolescent uptake, so the new data from the CDC should be no surprise. Indeed, again previously, when CEOs of two leading e-cigarette companies were \u201cgrilled\u201d by Senators, several important issues were revealed:\u003C\/p\u003E\n\u003Cp\u003E\u201cResponding to questions from Senator Boxer (D-California) about the flavors NJOY plans to introduce, Weiss made a slip, saying \u201cfor adults, we have single malt scotch.\u201d\u003Cbr \/\u003E\n\u201cAdult flavors?\u201d said Boxer. \u201cAs opposed to those for children.\u201d\u003Cbr \/\u003E\n\u201cThe only difference between your testimony today and testimony of the tobacco executives is that you are not under oath,\u201d said Senator Blumenthal. \u201cI find in your testimony a sense of denial that I cannot credibly accept because it is defied by the numbers. 18 million teens were exposed to blu\u2019s print TV ads in 6 months and NJOY\u2019s ads reached 3 million teens [these statistics come from the American Legacy Foundation report].\u201d (1)\u003Cbr \/\u003E\n\u201cThere is a legal principle that people are responsible for the natural and logical effects of what you do, and you know that you are reaching children.\u201d\u003C\/p\u003E\n\u003Cp\u003EIn the U.K. Moore et al have highlighted (3) that:\u003C\/p\u003E\n\u003Cp\u003E\u201cMany young people (including never-smokers) have tried e-cigarettes. However, regular use is less common, and is associated with tobacco cigarette use.\u201d\u003C\/p\u003E\n\u003Cp\u003EHowever, they warn that:\u003Cbr \/\u003E\n\u201cThere was limited evidence of patterning in adolescent e-cigarette use by sociodemographic factors . . . This is in very stark contrast to consistent evidence of a strong sociodemographic patterning in tobacco use among secondary-schools students . . . Public health professionals and policymakers are increasingly concerned that e-cigarettes will act as a new gateway into nicotine addiction and tobacco use for some young people if e-cigarettes are taken up widely at a population level. These data do suggest e-cigarette use could potentially spread throughout the youth population and become \u2018normalised\u2019, irrespective of socioeconomic status, ethnicity and gender . . .\u201d.\u003Cbr \/\u003E\nIf we presume that advertising influences behaviour, then the recent analysis by the E.U. Advocate General on new law regarding electronic cigarette advertising and sales (4) appears precautionary and proportionate, as: \u201ce-cigarettes possibly cause risks to human health and that that product could \u2014 above all in the case of adolescents and young adults \u2014 develop into a gateway to nicotine addiction and, ultimately, traditional tobacco consumption.\u201d\u003C\/p\u003E\n\u003Cp\u003EIndeed, as recently highlighted at an important scientific summit on E-cigarettes (5) there are \u201cLikely real and potential harms of e-cigarettes to users\u201d. These include \u201cExpected modest increases in risk of:\u003Cbr \/\u003E\n\u2022\tLung Cancer\u003Cbr \/\u003E\n\u2022\tEmphysema\/COPD\u003Cbr \/\u003E\n\u2022\tPulmonary Infection\u003Cbr \/\u003E\n\u2022\tCardiovascular events\u003Cbr \/\u003E\n\u2022\tPulmonary Fibrosis\u003Cbr \/\u003E\n\u2022\t(Hypersensitivity Pnuemonias)\u003Cbr \/\u003E\n\u2022\tOther cancers\u201d\u003C\/p\u003E\n\u003Cp\u003EAlthough Electronic Cigarettes may help some adult smokers, refractive to licensed therapies (6), quit tobacco, the current quality of evidence to support this, according to Cochrane Review, is \u201cLow\u201d or \u201cVery Low\u201d (7). What we should try to avoid is youth paying any price for any gains to adult health: this would be \u201cegregious\u201d, as previously argued (8). Hopefully, new law will reduce the risk of this. As elegantly stated previously: \u201cThe grave historical error in allowing cigarette marketing to flourish and the tobacco industry to thrive is no excuse for inadequate e-cigarette regulation. On the contrary, it is an incentive to ensure the best and safest possible regulatory environment.\u201d (9).\u003Cbr \/\u003E\nSenator Blumenthal \u2018s reported climax in the Hearing was thus: \u201cI think we have seen this movie before,\u201d . . . \u201cIt is called big nicotine comes to children near you and you are using the same kinds of tactics and promotions and ads that were used by big tobacco and proved so effective.\u201d (1)\u003C\/p\u003E\n\u003Cp\u003EThe new data from the CDC is gravely concerning.\u003C\/p\u003E\n\u003Cp\u003EDavid Bareham.\u003C\/p\u003E\n\u003Cp\u003E1.\tTIME Magazine: Electronic Cigarette Executives Get Schooled in Senate Hearing, Eliza Grey \u003Ca href=\u0022http:\/\/time.com\/2896962\/electronic-cigarette-executives-get-schooled-in-senate-hearing\/\u0022\u003Ehttp:\/\/time.com\/2896962\/electronic-cigarette-executives-get-schooled-in-...\u003C\/a\u003E\u003Cbr \/\u003E\n2.\tGateway to Addiction A Survey of Popular Electronic Cigarette Manufacturers and Targeted Marketing to Youth April 14, 2014 Senator Richard J. Durbin (D-IL) et al, April 2014 \u003Ca href=\u0022http:\/\/www.merkley.senate.gov\/imo\/media\/doc\/Durbin_eCigarette%20Survey.pdf\u0022\u003Ehttp:\/\/www.merkley.senate.gov\/imo\/media\/doc\/Durbin_eCigarette%20Survey.pdf\u003C\/a\u003E\u003Cbr \/\u003E\n3.\tMoore et al is \u201cElectronic-cigarette use among young people in Wales: evidence from two cross-sectional surveys\u201d, BMJ Open 2015;5:e007072 doi:10.1136\/bmjopen-2014-007072\u003Cbr \/\u003E\n4.\tAdvocate General Kokott considers the new EU tobacco directive of 2014 to be valid \u2013 Court of Justice of the European Union, Press Release No 154\/15, Luxembourg, 23.12.15\u003Cbr \/\u003E\n5.\t\u003Ca href=\u0022http:\/\/www.e-cigarette-summit.com\/files\/2015\/11\/1120-John-Britton.pdf\u0022\u003Ehttp:\/\/www.e-cigarette-summit.com\/files\/2015\/11\/1120-John-Britton.pdf\u003C\/a\u003E\u003Cbr \/\u003E\n6.\t\u003Ca href=\u0022http:\/\/www.ncsct.co.uk\/usr\/pub\/e-cigarette_briefing.pdf\u0022\u003Ehttp:\/\/www.ncsct.co.uk\/usr\/pub\/e-cigarette_briefing.pdf\u003C\/a\u003E\u003Cbr \/\u003E\n7.\t\u003Ca href=\u0022http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD010216.pub2\/abstract\u0022\u003Ehttp:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD010216.pub2\/abstract\u003C\/a\u003E\u003Cbr \/\u003E\n8.\t\u003Ca href=\u0022http:\/\/www.help.senate.gov\/hearings\/progress-and-challenges-the-state-of-tobacco-use-and-regulation-in-the-us\u0022\u003Ehttp:\/\/www.help.senate.gov\/hearings\/progress-and-challenges-the-state-of...\u003C\/a\u003E\u003Cbr \/\u003E\n9.\t\u003Ca href=\u0022http:\/\/www.ijdp.org\/article\/S0955-3959\u0022\u003Ehttp:\/\/www.ijdp.org\/article\/S0955-3959\u003C\/a\u003E(14)00210-2\/abstract\u003Cbr \/\u003E\n10. \u003Ca href=\u0022http:\/\/www.jeffreywigand.com\/7ceos.php\u0022\u003Ehttp:\/\/www.jeffreywigand.com\/7ceos.php\u003C\/a\u003E\u003C\/p\u003E\n\u003Cp\u003EN.B. The previous Tobacco Industry Testimony Blumenthal referred to is here. (10)\u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E08 January 2016\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n David W Bareham \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Specialist Respiratory Physiotherapist \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n Chartered Society of Physiotherapy \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Lincolnshire Community Health Services, Louth county Hospital, High Holme Road, Louth, Lincolnshire, LN11 0EU \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003C\/div\u003E\n \n \n \n \n \n \n\u003C\/div\u003E \u003C\/div\u003E\n\n \n \u003C\/div\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/body\u003E\u003C\/html\u003E"}